Falls around the world (FS-01)

Focused symposium

Hunter S1Hill K2Suttanon P3Smulders E4Johnson S5 
1University of Western Ontario, School of Physical Therapy, London, Canada, 2Curtin University, Perth, Australia, 3Thammasat University, Faculty of Allied Health Sciences, Pathumthani, Thailand, 4Radboud University Medical Centre, Rehabilitation, Nijmegen, Netherlands, 5University of Regina, Kinesiology and Health Studies, Regina, Canada

Learning objective 1: Describe global regional variations in occurrence and risk factors associated with falls in older adults.
Learning objective 2: Outline successful and effective falls prevention interventions that have support across many countries that can be used in physical therapy practice.
Description: Physiotherapists are in demand for their roles as health care providers for the growing proportion of older adults around the world. Importantly, while the aging of Western countries has been very prominent in public health discussions for meeting the needs of older adults, 70% of the older adult population lives in developing countries.1 Effective physical therapy treatment to regain or maintain independence continues to grow in importance in the field of older adult health. 
Falls are one of the most prominent public health challenges for older adults globally.2 Research provides strong evidence for falls prevention strategies for community-dwelling older adults. Prior to 2000, there was limited research for falls prevention in developing countries and yet guidelines from developed countries held prominence on the global stage for best practice. It is pragmatic to expect that the occurrence of falls will vary across countries and differences such as exercise preferences, and perceptions and expectations of aging may influence the success of implementing falls prevention strategies developed in other countries with dissimilar profiles. 
Among developed countries, it has been consistently established that between 20-30% of older adults living in the community will fall each year.3 In contrast, Williams et al.1 using data from the WHO's “Study on global AGEing and adult health (SAGE)” evaluated injurious falls in 6 low to middle-income countries. Falls prevalence ranged from 1.0% in South Africa to 6.6% in India, with a pooled average of 4.0% across the countries of China, Ghana, India, Mexico, the Russian Federation and South Africa. Conversely, Johnson et al. found 45% of community-dwelling older women in Kerala, India fell in a one-year time period and 75% sustained a fall-related injury.4 Nascimento et al.5 found a falls prevalence of 29% among community-dwelling older adults living in Sao Paolo, Brazil. In the scoping review by Romli et al.6, the yearly prevalence of falls was 10.4% to18.7% in Thailand, 17.2% in Singapore, 27.3% in Malaysia and 53.6% in the Philippines. . The wide variation in prevalence, from 1% to 54%, and their implications for the implementation of fall prevention programs will be addressed by the speakers at this focused symposium.
It is well established that falls are multifactorial and the provision of individualized interventions addressing identified risk factors can reduce the occurrence of falls and fall-related injury.7 Exercise is one of the best evaluated interventions and has been demonstrated to reduce falls by 21% in Western countries.8 The findings by Hill et al.9 on the effectiveness of falls prevention trials in Asia were generally consistent that exercise was effective, but they cautioned direct translation of guidelines and interventions from Western countries may not be effective in non-Western countries. 
A better understanding of the global variation in falls occurrences and success of interventions is needed to facilitate effective and optimal physical therapy interventions for older adults. A consideration of local issues to ensure that research and falls prevention programs implemented in non-Western countries are effective and relevant to the local context, people, and health system is emerging as very important. This symposium will provide the evidence to support the importance and need for falls prevention strategies for older adults across countries, including the importance of being responsive to local needs and values and learning from strategies that are successful in other countries.
Implications / Conclusions: Physiotherapists will benefit from exposure to a global view of falls prevention to optimize practice outcomes. The emerging research has implications for researchers, practitioners, policy and planning personnel, and research funders who may be involved in future falls prevention research and the practical implementation of guidelines in clinical practice. Overall, there needs to be consideration of local issues to ensure that research and falls prevention intervention programs implemented in non-Western countries are effective, and relevant to the local context, people, and health system. 
Key-words: 1. Accidental falls 2. Aged 3. Prevention
Funding acknowledgements: We would like to acknowledge the WCPT International Association of Physical Therapists working with Older People (IPTOP).
Relevance to physical therapy globally: Falls in older adults are a major public health problem across all countries. Physical therapists have a prominent role in the assessment and treatment of falls in older adults. The research that informs our understanding of falls and their prevention has come from high-income countries. Therefore, it is important to understand variation across countries in order to develop and implement successful fall prevention strategies that meet the unique needs of all older adults globally.
Target audience: This symposium will be relevant to physical therapists working in any practice settings and clinical areas serving rehabilitation of older adults (hospitals, community-based and institution-based).